The role of iron enhancer intake frequency in iron-deficiency anemia among adolescent girls in Purwokerto

Izka Sofiyya Wahyurin* -  Nutrition Science, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
Jennifer Novitasari -  Nutrition Science, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
Hiya Alfi Rahmah -  Nutrition Science, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia

Iron-deficiency anemia remains a critical health concern among adolescents, primarily influenced by dietary patterns that affect the bioavailability of iron. A 2023 screening in the Banyumas District reported a 36.7% prevalence of anemia among adolescent girls. This cross-sectional analytical study, conducted from August to September 2025, aimed to examine the association between the frequency and timing of meals of dietary iron enhancers and inhibitors and the risk of iron-deficiency anemia. Seventy-eight female students aged 14–17 years were selected using proportional purposive sampling. Hemoglobin levels were measured using a Hemoglobin Meter, with anemia defined as Hb <12 g/dL. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and 24-hour recalls, focusing on enhancer intake frequency (rarely: score <2.1; frequently: score ≥2.1) and the timing of consumption for both enhancers and inhibitors. Data analysis employed Chi-square and Fisher’s exact tests, with associations reported as Prevalence Ratios (PR). The prevalence of anemia was 39.3%. Frequent consumption of iron enhancers significantly reduced the risk of anemia by 84.7% compared with rare intake (PR = 0.153, p = 0.016). Conversely, frequent intake of inhibitors increased the odds of anemia (OR = 2.315, p = 0.008). Meal timing for both enhancers and inhibitors showed no significant association with anemia (p > 0.05). In conclusion, the frequency of iron enhancer intake is the primary dietary factor influencing anemia risk, outweighing the significance of its timing of consumption.

Keywords : Iron deficiency anemia, Adolescents, Iron enhancers, Iron inhibitors, School-based study

  1. Ahmad, F., Koller, D., Bruggraber, S., Pereira, D. I. A., Dainty, J. R., & Mushtaq, S. (2017). A 1-h time interval between a meal containing iron and consumption of tea attenuates the inhibitory effects on iron absorption: A controlled trial in a cohort of healthy UK women using a stable iron isotope. The American Journal of Clinical Nutrition, 106(6), 1413–1421. https://doi.org/10.3945/ajcn.117.161364
  2. Al Rahmad, A. H. (2023). Scoping Review: The Role of Micronutrients (Fe, Zn, Iodine, Retinol, Folate) During Pregnancy. Jurnal Kesehatan Manarang, 9(1), 1–13. https://doi.org/https://doi.org/10.33490/jkm.v9i1.812
  3. Gallo Ruelas, M., Alvarado-Gamarra, G., Aramburu, A., Dolores-Maldonado, G., Cueva, K., Rojas-Limache, G., Diaz-Parra, C. del P., & Lanata, C. F. (2025). A comparative analysis of heme vs non-heme iron administration: A systematic review and meta-analysis of randomized controlled trials. European Journal of Nutrition, 64(1), 51. https://doi.org/10.1007/s00394-024-03564-y
  4. Kolarš, B., Mijatović Jovin, V., Živanović, N., Minaković, I., Gvozdenović, N., Dickov Kokeza, I., & Lesjak, M. (2025). Iron deficiency and iron deficiency anemia: A comprehensive overview of established and emerging concepts. Pharmaceuticals, 18(8), 1104. https://doi.org/10.3390/ph18081104
  5. Kumar, S. B., Arnipalli, S. R., Mehta, P., Carrau, S., & Ziouzenkova, O. (2022). Iron deficiency anemia: Efficacy and limitations of nutritional and comprehensive mitigation strategies. Nutrients, 14(14), 2976. https://doi.org/10.3390/nu14142976
  6. Lee, J. (2023). Association between coffee and green tea consumption and iron deficiency anemia in Korea. Korean Journal of Family Medicine, 44(2), 69. https://doi.org/10.4082/kjfm.44.2E
  7. Nair, K. M., Fernandez-Rao, S., Nagalla, B., Kankipati, R. V., Punjal, R., Augustine, L. F., Hurley, K. M., Tilton, N., Harding, K. B., & Reinhart, G. (2016). Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India. Public Health Nutrition, 19(5), 861–871. https://doi.org/10.1017/S1368980015002050
  8. Nyakundi, P. N., Kiio, J., Munyaka, A. W., Galgalo, D. A., & Lohner, S. (2024). Consumption pattern of tea is associated with serum ferritin levels of women of childbearing age in Nandi county, Kenya: A cross-sectional study. Annals of Nutrition and Metabolism, 80(2), 109–116. https://doi.org/10.1159/000536196
  9. Piskin, E., Cianciosi, D., Gulec, S., Tomas, M., & Capanoglu, E. (2022). Iron absorption: Factors, limitations, and improvement methods. ACS Omega, 7(24), 20441–20456. https://doi.org/10.1021/acsomega.2c01833
  10. Rani, V., Moretti, D., Khetarpaul, N., Thankachan, P., Zimmermann, M. B., Melse-Boonstra, A., & Brouwer, I. D. (2024). Vitamin C-rich guava consumed with mungbean dal reduces anemia and increases hemoglobin but not iron stores: A randomized controlled trial of food-to-food fortification in Indian children. The Journal of Nutrition, 154(12), 3740–3748. https://doi.org/10.1016/j.tjnut.2024.10.042
  11. Samson, K. L. I., Fischer, J. A. J., & Roche, M. L. (2022). Iron status, anemia, and iron interventions and their associations with cognitive and academic performance in adolescents: A systematic review. Nutrients, 14(1), 224. https://doi.org/10.3390/nu14010224
  12. Skolmowska, D., & Głąbska, D. (2022). Effectiveness of dietary intervention with iron and vitamin C administered separately in improving iron status in young women. International Journal of Environmental Research and Public Health, 19(19), 11877. https://doi.org/10.3390/ijerph191911877
  13. Wahyurin, I. S., & Rahmah, H. A. (2021). Amount of menstrual blood and nutrient intake with hemoglobin level. KEMAS: Jurnal Kesehatan Masyarakat, 17(1), 31–36. https://doi.org/10.15294/kemas.v17i1.24540
  14. Wati, E. K., Sistiarani, C., & Rahardjo, S. (2023). Diet behavior and consumption of iron inhibitors: Incidence anemia in adolescent girls. Journal of Public Health in Africa, 14(11), 2593. https://doi.org/10.4081/jphia.2023.2593
  15. Yani, M., Azhari, A., Al Rahmad, A. H., Bastian, F., Ilzana, T. M., Rahmi, C. R., Andriaty, S. N., Chanda, A., & Salsabila, S. (2023). The relationship between menarche and nutritional status in Junior High School students in Aceh Besar. A study from 30 years of armed conflict area, Aceh, Indonesia. AcTion: Aceh Nutrition Journal, 8(4), 635–641. https://doi.org/10.30867/action.v8i4.1310
  16. Zulfikar, R. R. O., Mariani, E., Gunawan, C., Sitorus, N. L., Dilantika, C., Sundjaya, T., Pelangi, B., & Basrowi, R. W. (2025). Improving iron deficiency anemia (IDA) prevention and management strategies in Indonesia: An expert opinion. The Open Public Health Journal, 18(1). http://dx.doi.org/10.2174/0118749445361508250602094137

Open Access Copyright (c) 2026 Izka Sofiyya Wahyurin, Jennifer Novitasari, Hiya Alfi Rahmah
Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
Soekarno-Hatta Street, No. 168. Health Polytechnic of Aceh, Aceh Besar, 23352. Telp/Fax: 0651 46126 / 0651 46121.
Website: https://gizipoltekkesaceh.ac.id/
E-mail: jurnal6121@gmail.com

e-issn: 2548-5741, p-issn: 2527-3310

All content is licensed under a: Creative Commons Attribution ShareAlike 4.0 International License

View My Stats

Get a feed by atom here, RRS2 here and OAI Links here